Department of Conservative Dentistry and Endodontics, Prabhu Dayal Memorial Dental College and Research Institute, Bahadurgarh, Haryana, India.
Int Endod J. 2011 Jun;44(6):574-82. doi: 10.1111/j.1365-2591.2011.01868.x. Epub 2011 Feb 22.
To present the successful endodontic and periodontal management of a two rooted maxillary lateral incisor tooth with a complex radicular lingual groove and severe periodontal destruction using spiral computed tomography as a diagnostic aid.
A 30-year-old male patient presented with a chief complaint of mobility and discharge of pus in an upper front tooth. Clinical examination revealed a sinus tract on the labial gingival surface and a 10-mm-deep periodontal pocket associated with maxillary left lateral incisor tooth. On the lingual side, a groove emerging from cingulum, continuing mesioapically down the lingual aspect of tooth was found. Intraoral periapical radiographs demonstrated a lateral periodontal defect around the mesial aspect and a diffuse radiolucency at the apex of maxillary left lateral incisor tooth. The sinus tract was traced with gutta-percha to the maxillary left lateral incisor that showed an accessory root surrounded by a large radiolucent area. A spiral computed tomographic scan for better understanding of the complicated root canal morphology of the tooth was performed. Based on the clinical, radiographic and spiral computed tomographic findings, a diagnosis of an endo-perio lesion in tooth 22 was made. Management consisted of conventional root canal treatment, radiculoplasty, root resection of accessory root and surgical curettage of the periodontal defect. Follow-up with radiographic examination at 3 months and 1 year was performed. At 1-year recall, the patient was asymptomatic, there was no evidence of the sinus tract and a 3-mm nonbleeding pocket was present in relation to tooth 22. Progression of hard tissue healing was observed in the periapical radiograph taken 1 year postoperatively.
The key to achieving favourable results in this particular type of developmental anomaly is accurate diagnosis and treatment planning. The health of the periapical osseous tissues appears to be the provital factor for tooth retention. A favourable outcome can only be achieved with a comprehensive treatment approach that effectively manages all local factors that are contributing to the disease process.
使用螺旋 CT 作为诊断辅助手段，成功治疗上颌侧切牙的双根、复杂根舌侧沟和严重牙周破坏的牙髓病和牙周病。
一名 30 岁男性患者因上前牙松动和溢脓就诊。临床检查发现唇侧牙龈表面有窦道，左上侧切牙有 10mm 深牙周袋。在舌侧，从牙冠的龈缘处出现一条向近中延伸至舌侧的沟。口腔内根尖片显示近中颊侧牙周缺损和左上侧切牙根尖弥散性透光区。窦道用牙胶追踪至左上侧切牙，发现有一个副根管，周围有一个大的透光区。为了更好地了解牙齿复杂的根管形态，进行了螺旋 CT 扫描。根据临床、影像学和螺旋 CT 检查结果，诊断为 22 号牙的牙髓-牙周病变。治疗包括常规根管治疗、根管成形术、副根管切除术和牙周缺损的外科刮治。术后 3 个月和 1 年进行随访，拍摄 X 线片。1 年后复诊时，患者无症状，窦道无证据，22 号牙有 3mm 非出血袋。术后 1 年的根尖片显示硬组织愈合有进展。
在这种特殊类型的发育异常中，取得良好效果的关键是准确的诊断和治疗计划。根尖周骨组织的健康似乎是保留牙齿的关键因素。只有通过综合治疗方法，有效管理导致疾病进程的所有局部因素，才能取得良好的结果。
